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Talking about Abortion, Part V: Physicians Weigh In

Predictably, we got a lot of response to the latest set of questions and answers from the three anti-abortion readers. We'll be running some of those on Sunday, of course.

That said, we do want to address one point. We got a fair number of messages pointing out that we criticized CNN for bothsides-ism last week, and suggesting that by giving perspectives on both sides of the abortion issue, we are guilty of the same. We get plenty of unkind and/or critical e-mails, and that's not a problem because it comes with the territory. But we are not pleased by the implication that we are hypocrites.

When CNN has a town hall with Donald Trump, or when The Washington Post runs the knee-jerk columns of Hugh Hewitt, or when MSNBC sticks some Republican into their lineup of talking heads on election night, we are not left with the impression that there's an honest attempt to illuminate things for viewers/readers. No, we are left with the impression that they are trying to be all things to all people, in search of eyeballs/ratings, and/or that they are trying to undermine criticism that they are "biased." Maybe our impressions are right, and maybe they are wrong, but when we look at something like the Trump event, we have a very, very hard time believing that CNN staged that out of some sense of civic duty.

By contrast, as we have already explained, these abortion questions and answers came about because we got a questions in the mailbox about "what anti-abortion advocates think" that we were not in a position to answer. We eventually built up so many of these that we sought out people who are able to answer. In response to the feedback we got to the first installment of that, it occurred to us that it would be best to also hear from some readers who serve as a counterpoint. To the extent there's any bothsides-ism going on, it's that we added the pro-choice perspectives, not that we ran the anti-abortion perspectives in the first place.

But the fact is that it's not bothsides-ism. Our motivation isn't to drive page views or attract subscribers or any of that. We are not making a largely empty gesture in response to criticism from outsiders. We are both educators, and we concluded that, for at least some readers, this exercise is instructive. That's where our motivation begins and ends. We have plenty of e-mails that suggest we are correct about this; they are far more numerous than the unkind e-mails.

Today we are going to run a couple of messages we got from physicians. We expect to run two more items with comments from the anti-abortion readers, and we hope to run one more item with the experiences of people who needed an abortion (or who needed to strongly consider it), and one more with the experiences of physicians in the post-Dobbs world. We already have some letters in the former category, and would welcome more. We don't have any more in the latter category; we'll see what happens if we give a little bit more time. Here's the place to send those for readers willing to be a part. If you have questions, or you need to be anonymous, you can send messages there, too, and we can have the necessary discussion.

And with that out of the way, let's hear from the doctors, starting with a response to the account from the story of T.C. in St. Paul, MN:

A.R. in Raleigh, NC, writes: T.C. shows great bravery and vulnerability in sharing her personal pregnancy termination story. We are all enriched by hearing her first-person account of the trauma faced by those who seek abortions, and the difficulty with which they arrive at their decision. Her story is of course her own, representing powerful testimony, even though the level of evidence is anecdotal. But I think there are several themes that can be identified within her record that I would like to expand upon as they segue into the greater body of abortion-care data.

While many Republican legislators attempt to soften abortion bans by permitting abortion for the health and life of the mother, it is not as humane a policy as they might make it appear. For a woman to receive an abortion legally under this clause it, unfortunately, requires the pregnant person to first become ill prior to an abortion becoming a legal option. It prevents individuals from making an informed decision based upon their current health status, medical history, and medical comorbidities on whether the risks of continuing the pregnancy are justified, or whether a pregnancy termination is the right choice for them in order to prevent an illness from occurring (or worsening). As T.C.'s account indicates, she had a plethora of studies performed yet no diagnosis was identified as the cause of her symptoms; without a diagnosis, a provider would not be able to justify a pregnancy termination using a "health and life of the mother" exception. If her suspicions were correct and she did have early and undiagnosed stages of a developing cardiomyopathy and her cardiomyopathy were to worsen as the pregnancy continued, she would've likely decompensated, had a multiple day hospitalization, and spent some of the time in the cardiac intensive care unit at a tertiary care center. She would've likely required invasive monitors, vascular access lines, and other urgent/emergent procedures. She very well might have died—cardiovascular disease is the #1 cause of maternal death in pregnancy and the postpartum period in the United States.

Which leads to another critically important point in T.C.'s account: how family and loved ones impacted her decision. When her best friend said "Don't sacrifice yourself to give your daughter a sibling," T.C. chose to end the pregnancy in order to maximize the chances that she will be around to care for her daughter and to be in the lives of her friends and loved ones. There is an unfortunate stereotype that women who receive abortions are immature teenagers who simply do not want to face the consequences of their actions. In fact, the data show that the majority of women who choose to have a pregnancy termination are in fact mothers. They are choosing to terminate a pregnancy so that they can dedicate themselves to their existing children. These women are thinking of what is best for their family.

T.C. also reports that this pregnancy was unplanned, but once she learned she was pregnant she was excited to carry the pregnancy. There are many, many stories of women who truly wanted to grow their family, yet are heartbroken when they feel forced to terminate their pregnancy because an issue arose in the pregnancy. Many second-trimester abortions are performed after ultrasound studies identify a fetal anomaly, or the woman develops a high-risk obstetric or medical problem. Thus, abortion bans with gestational age cutoffs in the late first or early second trimester and uniquely cruel as they reduce only a handful of abortions (as the great majority of abortions are performed in the first trimester), and disproportionately affect women who truly wanted to have a baby but find themselves in high-risk medical situations. It adds an additional level of emotional and psychological trauma when those women are forced to travel to another state to terminate the pregnancy.

The final point that is worth noting in T.C.'s record is that she was truly surprised to find herself pregnant because she assumed her risk of pregnancy was low. Over half of pregnancies in the United States are unplanned. Women who previously struggled with infertility, are perimenopausal, or are using an effective form of contraception get pregnant all the time despite assuming that they could not. Unfortunately most women don't notice the early symptoms of pregnancy or assume it couldn't be a pregnancy because of these aforementioned conditions. These women, as well as others (for instance, those who are using contraception that prevents them from having periods or those with irregular menses), are essentially excluded from ever having access to an abortion in states with 6-week abortion bans, and many may not realize they are pregnant for many weeks beyond that. The end result is that the state unintentionally, but effectively, discriminates against these women as a consequence of their existing medical comorbidities.

Again, I want to recognize the courage that T.C. demonstrated by describing her abortion experience, and we should all be grateful for her openness and honesty with an experience that many would deem to be incredibly private. Thank you for sharing.

J.D. in Portland, OR, writes: In medical school, I did an elective rotation at an abortion clinic, purely out of my political support for choice (full disclosure). I remember the range of women who came in through the security doors into the bullet-proof-glassed waiting room—almost all of them openly struggling with what was such a difficult decision for them: young, affluently-dressed, professional women struggling with shame, shame that they probably rightly-assumed a male medical student could not fathom, women struggling with poverty, women struggling with addiction (later, as a child psychiatrist who would work with the sometimes-relentless consequences of in-utero substance exposure, I would come to see such women in particular with deep respect for their choices either way). The great privilege of the many years of medical training is the sheer range of people from all walks of life and experience that you get to meet—even the most well-traveled person cannot imagine it.

The case that affected me the most was a blue-collar mother of three. She worked as a prison correctional officer (I volunteered in prisons and jails before medical school and later worked for a time as a prison psychiatrist with both teens and adults, and so I have a special affinity for such colleagues), and she had taken time off work to drive well over an hour for the procedure. (I know—nothing like the distance other women travel.) In blue scrubs, my soft-voiced attending knelt down between her legs and performed the procedure with the utmost kindness, as this mother sobbed her heart out, about how she and her husband could not afford to have this baby. You can imagine how often I think of her when reading about economic policy on this site.

Thanks to A.R. and J.D. for their perspectives. Again, we'll have responses to this week's entries on Sunday. (Z)

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